What is breast cancer?
Breast cancer develops when abnormal cells in the breast tissue start to divide uncontrollably, damaging surrounding tissue and often forming masses called tumours.
Breast cancer has many symptoms, but the first symptom that many women notice is a lump in their breast.
Breast cancer surgery
Breast cancer surgery is often performed to remove the cancerous cells, but other therapies, including chemotherapy, radiation therapy and hormone therapy, are also used to kill any remaining cancer cells and reduce the risk of cancer returning.
What is a mastectomy?
A mastectomy is a surgical procedure to remove breast tissue affected by cancer cells. There are several different types of Mastectomy.
Total Mastectomy
A total mastectomy involves removing the entire breast, including both cancer cells and normal breast tissue.
A mastectomy is major surgery, but your surgical oncology specialist may advise you that removing all the breast tissue is the best treatment option for you in several circumstances:
- You have a large mass or multiple tumours in your breast
- You have had a local recurrence in the same breast after having had radiotherapy previously
- Genetic factors or family history indicate that you are at high risk of cancer cells remaining in your breast tissue
- You have been diagnosed with a highly invasive breast cancer
- You are extremely anxious about the breast cancer coming back after a lumpectomy
Some women have double mastectomies to make recurrence even less likely. Many of our patients who have had total mastectomies of one or both breasts choose to have breast reconstruction surgery to restore shape to their chest area.
Nipple sparing Mastectomy
Nipple sparing mastectomy is a type of oncoplastic breast surgery where the breast tissue is removed, but the skin envelope, the areola and nipple are preserved. After this procedure, women often have reconstructive surgery straightaway using breast prostheses ( breast implants).
Women with early-stage breast cancer may be good candidates for a nipple sparing Mastectomy.
Skin-sparing Mastectomy
This procedure is very similar to the above, except that the nipple and areola are removed.
Women who have a skin-sparing mastectomy also have the opportunity to have immediate reconstruction.
Lumpectomy: Partial Mastectomy
A lumpectomy, sometimes called breast conserving surgery or a partial mastectomy, is a less invasive procedure to remove only the area affected by the cancer, including the mass of cancer cells and a margin of healthy tissue surrounding the lump. The goal of this type of surgery is to preserve the appearance of the breast whilst also delivering successful therapeutic outcomes.
This approach is usually only considered for women with primary breast cancer where the tumour is small and has not spread to the lymph nodes.
It may still be necessary to undergo radiation therapy or other adjuvant therapy after a lumpectomy to ensure that all the cancer cells have been eliminated.
Preventive breast surgery without a breast cancer diagnosis
Some women are at a higher risk of developing breast cancer than the rest of the population due to the presence of a gene mutation, often BRCA1 or BRCA2.
They may choose to have a double mastectomy that involves the removal of the healthy tissue of the whole breast on both sides to prevent the development of breast cancer in the future.
Lumpectomy or breast conserving surgery is not an option for women affected by these gene mutations, but many can have a nipple saving mastectomy followed by breast reconstruction.
Lumpectomy vs Mastectomy: advantages and disadvantages
Each procedure has its own advantages and disadvantages, and your breast surgeon will discuss the following areas with you when you are making the decision about which to choose.
Breast cancer recurrence
As a mastectomy involves the removal of the entire breast, it reduces the risk of breast cancer recurring in that breast to almost zero.
There is remaining breast tissue after a lumpectomy surgery, but studies have shown that radiotherapy treatment after lump removal reduces the risk of recurrence to a similar level as after Mastectomy.
Other variables, such as the size and location of the tumour, also affect recurrence.
Recovery time
Most women find that it takes longer to recover from a mastectomy than from a lumpectomy.
Mastectomy is a more invasive procedure with a wide local excision that brings a higher infection risk and a longer recovery before normal activity can be resumed.
Unlike Mastectomy, which often requires an overnight stay, lumpectomy patients can often return home on the day of their procedure.
Requirement for additional treatments
Patients often receive additional therapies after both procedures, with radiation therapy often being recommended after lumpectomy.
Aesthetic and psychological considerations
As it is a less invasive surgery, lumpectomy often results in an outcome that is less psychologically challenging to breast cancer patients than a total mastectomy.
However, even breast conserving surgery lumpectomy may leave changes to the appearance of the breast that the patient finds hard to deal with.
Patients who have lumpectomies have the option of breast reconstruction surgery, which can restore the shape and size of the breasts with excellent aesthetic results.
Making your decision about lumpectomy vs mastectomy
Your consultant will advise and support you throughout the decision-making process. The areas for discussion and consideration include:
- The stage and size of your breast cancer tumour and how invasive it is
- Whether you have had breast cancer previously and how it was treated, for example, can you safely tolerate additional radiation required after lumpectomy?
- A strong family history of breast cancer or the presence of BRCA gene mutations, which may indicate a high risk of recurrence within the breast tissue
- Strong personal feelings on the subject
At Birmingham Breast Clinic, you will be treated by a multidisciplinary team, and your case will be considered by your breast surgeon, radiation oncologist, and other professionals to ensure you receive the best advice and personalised treatment to achieve an excellent outcome.
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